P943: SURVIVAL OUTCOMES OF PATIENTS WITH MULTIPLE MYELOMA IN FRANCE: A COHORT STUDY USING THE FRENCH NATIONAL HEALTHCARE DATABASE (SNDS)
Authors: X. Leleu, B. Gorsh, A. Bessou, P. Paka, J. De Nascimento, X. Colin, S. Landi, P. F. Wang
Journal: HemaSphere (2022)

Background: While treatment options for multiple myeloma (MM) have expanded with the introduction of novel therapies, it remains unclear how this has translated into better patient outcomes. Although some patients can achieve long-term remission, MM remains incurable. In oncology, overall survival (OS) is the gold standard for measuring the clinical benefit of an agent. Real-world studies in several countries have shown increases in OS in recent years for patients with MM; up-to-date real-world data on MM survival in France are limited. Aims: To assess the OS of patients with MM in France from diagnosis and by line of therapy (LOT) and post triple-class exposure (TCE). Secondary aims were survival outcomes by different subpopulations based on standard of care (SoC) treatment regimens and transplant status. Methods: This longitudinal retrospective cohort study used data from the French National Healthcare database (Système National des Données de Santé – SNDS) from Jan 2013‒Dec 2019, which included records of outpatient claims, hospital discharges and death registry, demographics, and reimbursement data for hospital and outpatient services. Eligible patients (≥18 years) had ≥2 records of an MM diagnosis (ICD-10 codes C90/C90.0), and/or long-term disease during the study period; ≥1 dispensation/administration of MM drug treatment and date of death available. LOT was algorithmically defined based on drug regimen, time since administration, and gap between regimens. OS was analyzed from five time points: 1) from time of diagnosis; 2) from the start of line of LOT1 to LOT4; 3) from the start of first TCE (defined as prior exposure to a proteasome inhibitor, an immunomodulatory agent and an anti-CD38 monoclonal antibody); 4) from the subsequent treatment following TCE, and 5) from the subsequent treatment/no treatment following TCE and LOT5+ (indexed at the date of the last observed treatment). Patient OS was assessed by Kaplan–Meier method and death rates were calculated. Results: A total of 14,309 patients were included in this analysis. Median age was 71 years at diagnosis and 51% of patients were male. Patient survival outcomes deteriorated as their LOT advanced (Figure). Median OS from initial diagnosis was >5 years with a slight increase for patients diagnosed more recently (63.8 months for patients diagnosed in 2017 or later vs 60.8 months in those diagnosed in 2014 or later). From LOT1 to LOT4 OS decreased from 61 to 14.8 months or about 30% to 50% with each additional LOT. At the time of first TCE, daratumumab monotherapy/combination therapy were the most common regimens. Median OS following TCE was 3.8 months. Retreatment with previous agents were the SoC following TCE. Among TCE patients who had 4 prior LOTs, 43% of them received a subsequent LOT with a median OS estimate of 8.2 months. For those who discontinued treatment, median OS was only 1 month, indexing at the date of the last observed treatment. Image:Summary/Conclusion: Patients with MM experience worsening survival outcomes with increasing time from diagnosis and with subsequent LOT. Prognosis was especially poor among TCE patients who received subsequent therapy and worse for those who did not receive additional treatment. Despite therapeutic advances and slight increase in OS for patients diagnosed more recently, an unmet need for improved access to novel therapies remains, especially in those TCE patients.